State v. Bamonte

2022 Ohio 1331
CourtOhio Court of Appeals
DecidedApril 21, 2022
Docket19AP-875
StatusPublished

This text of 2022 Ohio 1331 (State v. Bamonte) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State v. Bamonte, 2022 Ohio 1331 (Ohio Ct. App. 2022).

Opinion

[Cite as State v. Bamonte, 2022-Ohio-1331.]

IN THE COURT OF APPEALS OF OHIO

TENTH APPELLATE DISTRICT

State of Ohio, :

Plaintiff-Appellee, : No. 19AP-875 v. : (C.P.C. No. 18CR-1347)

Anthony Bamonte, : (REGULAR CALENDAR)

Defendant-Appellant. :

D E C I S I O N

Rendered on April 21, 2022

On brief: Dave Yost, Attorney General, Benjamin W. Karrasch, Steven T. Darnell, Kristin Pe, and Megan E. Grant- Lee, for appellee. Argued: Steven T. Darnell.

On brief: Todd W. Barstow, for appellant. Argued: Todd W. Barstow.

APPEAL from the Franklin County Court of Common Pleas MENTEL, J. {¶ 1} A jury found defendant-appellant, Anthony Bamonte, guilty of grand theft under R.C. 2913.02(A)(3) and Medicaid fraud under R.C. 2913.40(B) in the Franklin County Court of Common Pleas. His appeal challenges the legal sufficiency of the state's evidence and its manifest weight, but as discussed below, we find no merit to either argument and affirm the findings of guilt. However, our review of the record shows that the trial court committed plain error by failing to merge the convictions as allied offenses of similar import under R.C. 2941.25. Accordingly, we affirm in part, reverse in part, and remand for resentencing. I. Factual and Procedural History {¶ 2} On March 20, 2018, plaintiff-appellee State of Ohio filed a two-count indictment against Mr. Bamonte. Count 1 alleged that between March 19, 2011 and No. 19AP-875 2

September 9, 2015, he committed grand theft as defined in R.C. 2913.02(A)(3) by obtaining Ohio Department of Medicaid ("ODM") funds by deception, in an amount over $5,000 but less than $100,000. Count 2 alleged that from March 14, 2011 to September 9, 2015, he committed Medicaid fraud under R.C. 2913.40(B) by using false or misleading statements or representations to obtain reimbursement, in an amount over $5,000 but less than $100,000. Before trial, the state amended both counts to allege that the amounts Mr. Bamonte stole were in excess of $7,500 and less than $150,000. The state also amended Count 2 to allege that Mr. Bamonte committed the fraud between October 1, 2011 and September 9, 2015. (Aug. 26, 2019 Tr. at 5.) {¶ 3} A seven-day trial commenced on August 26, 2019. The state's case alleged that Mr. Bamonte defrauded ODM by filing unauthorized claims on behalf of Medicaid recipients for durable medical equipment ("DME") and medical supplies, based on recipients' information obtained from home health care agencies with which his company, ADB Medical Supplies, had done business. The state supported its allegations with testimony from ODM investigators, Medicaid recipients, and owners and employees of home health care agencies. {¶ 4} Don Sabol testified about his work at ODM's Bureau of Health Plan Policy as the Medicaid health system administrator, where he oversaw the rules governing DME claims. Id. at 398-99. He explained that the Ohio Administrative Code defines DME, which is covered by Medicaid, as "equipment that can stand repeated use, is primarily and customarily used to serve a medical purpose, is not useful to a person in the absence or illness or injury, and is appropriate for use in the home." Id. at 404. In contrast, "[s]upplies are basic consumables or disposable things not designed for repeated use." Id. at 399. Mr. Sabol explained that under the Medicaid reimbursement rules, "when Medicaid pays for a physician visit or a home health visit, certain items are considered to be necessary for the provision of that service," including supplies such as gloves. Id. at 406. Such items are "included in [the] reimbursement" for the service and not subject to a separate reimbursement. Id. In other words, "Medicaid will not pay for something that's already included in a payment for a professional service." Id. at 407. {¶ 5} The rule applies as well to home health services, Mr. Sabol explained. Thus, "supplies for services included in payments to home health companies for home health No. 19AP-875 3

services [are] built into the rate" and are "the cost of doing business" for those providers. Id. at 408. According to Mr. Sabol, a DME or medical supply company should not bill Medicaid using a recipient's number for gloves it furnishes because "[t]he recipient is not receiving the actual supply item." Id. at 408-09. Rather, the supply company should be sending the bill to "[t]he home health agency" that uses the gloves. Id. at 409. As an example of when Medicaid would pay for gloves, Mr. Sabol explained that "[t]he patient and prescriber would have to initiate the process for the order" and that gloves would only be justified in the case of "[c]ertain conditions," including post-surgical wound care. Id. However, he emphasized that it would never be appropriate for a DME company to bill Medicaid for gloves used by a home health agency. Id. at 410. Mr. Sabol also explained that in order for a company to obtain Medicaid reimbursement for DME, the regulations require it to have conforming paperwork that includes a signed and dated "legible prescription from an eligible prescriber" based on a "face-to-face examination," a patient file or "a form or certificate of medical necessity," and "proof of delivery" of the equipment. Id. at 412. He testified that ODM should not pay for medical supplies without meeting such requirements or for supplies that a patient did not receive. Id. at 413-14. {¶ 6} Patrick Tighe, the bureau chief of Claims Operations at ODM, testified about the agency's Medicaid claims process. Id. at 849-50. He authenticated the "remittance advices" the agency generated showing payments made to ADB Medical Supplies for Medicaid claims. Id. at 854. He also explained that ODM does not have "any independent way" of verifying the information in a provider's claim, such as whether a doctor's order exists to support it, and must rely on the truthfulness of the provider to "know what to pay and what to process." Id. at 865. ODM processes "a little over a million claims a week." Id. at 866. {¶ 7} Rachel Jones, the Section Chief of ODM's Surveillance and Utilization Review Section, testified about the agency's fraud investigation that resulted in a referral to the Ohio Attorney General. Id. at 210. She explained that ODM sent out explanation of medical benefits ("EOMB") letters "on a monthly basis asking [Medicaid] recipients to verify the services that were paid in the previous month on their behalf." Id. at 211. Ms. Jones explained that if a Medicaid recipient has not received the services listed on the EOMB, the recipient is asked "to indicate that on the letter" and return it in an enclosed envelope. Id. No. 19AP-875 4

at 213. Based on EOMB letter responses received from Medicaid recipients, ODM referred ADB Medical Supplies to the Ohio Attorney General. Id. The referral occurred after a claims review process in which Ms. Jones and her staff noticed "[v]ery strange billing patterns" by ADB Medical Supplies, including "billing for a year's worth of services in one claim" or for services performed a year before the billing date. Id. at 214-15. Her staff also "reached out" to the Medicaid recipients who had responded to confirm that "they had not received the services" in question. Id. at 216. Ms. Jones stated that her office only referred potential fraud cases to the Ohio Attorney General when the EOMB letter recipient's response "clearly states they did not receive the supplies and they know nothing about the supplies." Id. at 260. {¶ 8} Mike McCabe also testified about the work of ODM's Surveillance and Utilization Review Section, where he monitored the EOMB letter program. Id. at 368-69. His investigation started when he "received two letters on consecutive days from two different people claiming that they had not received the products that ADB had billed for and were paid [for]." Id.

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2022 Ohio 1331, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-v-bamonte-ohioctapp-2022.